Diabetes
Mellitus
was first recorded as a disease associated with “sweet urine” in
ancient China. Diabetes Mellitus is commonly referred to as
diabetes. It is a group syndrome with metabolic diseases and
hyperglycemia, which results from defects in insulin secretion,
insulin action, or a combination of both.

Type-1 diabetes is due to decrease in or the complete absence of the
secretion of insulin. Blood glucose levels are normally maintained
by insulin, which is a kind of hormone and produced by the pancreas,
a large gland located behind the stomach. Glucose, the form of sugar
in the blood, is the main source of fuel for the human body. After
the food is digested, glucose enters the bloodstream.

When the blood glucose is elevated, insulin is secreted from the
pancreas to regulate the glucose level, therefore the glucose is
able to get into cells and utilized by cells for energy and growth.
When a person is developing diabetes, the inadequate or deficiency
production of insulin will result in hyperglycemia. Diabetes is a
chronic disease, with multiple and complicated conditions, although
it can be controlled for a while, but the medical condition and
complication will continue getting worse with the lifetime. An
elevated level of blood glucose overflows into the urine and passes
out of kidney, hence the term sweet urine.

The four main types of
diabetes according to Western Medicine are:

·Type 1
diabetes

·Type 2
diabetes

·Gestational
diabetes

·Other specific
diabetes

Type I diabetes

Over 90% of type I diabetes is the autoimmune-mediated type of
diabetes. Only less than 10% of them is idiopathic type of type I
diabetes. This idiopathic type has no evidence to support that the
body developed autoimmunity against the pancreatic beta cells,
causing insulinopenia or ketoacidosis.

autoimmune response to attack the pancreatic beta cells in the
Islets of Langerhans of the pancreas.

The autoimmune process damages and destroys the insulin-producing
beta cells either against beta cell antigens or against the
molecules of the beta cells resembling the viral proteins such as
found in the Coxsackie virus family. Some toxic chemical agents and
drugs specifically target the pancreas and selectively kill
pancreatic beta cells, resulting in loss of insulin secretion and
development of Type 1 diabetes. Special HLA immune response genes
are also believed to cause the absent or insufficient insulin
secretion (insolinopenia). Trauma, tumors or pancreatitis can also
lead to loss of insulin secretion.

Some researchers believe that the antibodies against cow's milk
proteins is also one of the factors triggering the autoimmune
response. However, today no one know how the immune system attacks
the beta cells, but most scientists believe that this catabolic
disorder likely is possible from genetic influence, drug agents,
toxic chemicals, viral infection, and free radicals.

Type 1 diabetes, known as childhood diabetes, juvenile diabetes,
Insulin-Dependent Diabetes Mellitus' (IDDM), Juvenile Onset
Diabetes, it is most commonly increased in children before school
age and young adults around puberty, but it can also happen at any
age.

The incidence rate between adult and children diabetes is the same.
Many adult with Type 1 diabetes is misdiagnosed as Type 2 diabetes.
Gender of Type 1 diabetes has an equal ratio among males and
females. Whites are more common than non-whites. However, some
countries in Northern Europe, including Finland and Sweden, have a
higher incidence of Type 1 diabetes. The reason for this is unknown.

In Type 1 diabetes, the pancreas does not secret or secret little
insulin. Insulin is a hormone, which convert the blood sugar,
starches, and other food into energy for daily life. Most of the
time, the beta cell destruction already begin years earlier before
the symptoms appear.

The destruction rate of the beta cells can be quite different. Some
persons shows the symptoms rapidly, but some other person may be
very slow to develop the symptoms. If the Type 1 diabetes patient
with hyperglycemia is untreated properly with insulin, it can lead
to a life-threatening ketoacidosis, known as diabetic coma, or even
death. The Type 1 diabetes also increases higher risk for many
serious complications. The most complications of Type 1 diabetes
include: retinopathy, cardiovascular disease, neuropathy,
nephropathy, etc.

The symptoms of Type 1 diabetes usually develop suddenly once the
circulating insulin is diminished or virtually absent. The
consequence is because the pancreatic beta cells fail to respond to
all insulinogenic stimuli. The major symptoms include polyuria,
thirst, polydipsia, polyphagia with weight loss, nocturnal enuresis,
and extreme fatigue or weakness.

The sustained hyperglycemia causes the increased urination because
of the increase of osmotic diuresis. Because the kidney excretes the
excess glucose, free water and electrolytes are continually lost
into the urine. A person expectedly develops a mild hyperosmolar
state at the beginning. Postural hypertension occurs due to the
lowered plasma volume. The thirst and blurred vision appears due to
the hyperosmolarity.

Due to failure of the body cells to upload and utilize glucose,
protein is used for energy. The catabolism of muscle protein and
loss of potassium cause the weakness and fatigue. Weight loss with
polyphagia is due to loss of triglycerides, water and glycogen from
the muscle. When ketone bodies, a side product from protein
metabolism, are present in the body for a long time in elevated
levels, serious illness or coma can result.

The lab test shows a random (taken any time of day) plasma glucose
value of 200 mg/dL or more, or a fasting plasma glucose value of 126
mg/dL or more after a person has fasting diet for 8 hours.

The fasting plasma glucose test is much more reliable and preferred
test for diagnosing Type 1 or Type 2 diabetes when it is done in the
morning. Or an oral glucose tolerance test show the plasma glucose
value of 200 mg/dL or more in a blood sample taken 2 hours after the
patient has a drink containing 75 grams of anhydrous glucose
dissolved in water and then measuring the plasma glucose
concentration 2 hours later at timed intervals over a 3-hour period.
The most effective laboratory test to distinguish a Type 1 or Type 2
diabetes is the C-peptide test, which obtain the amount of insulin
being secreted in the body.

Type 2 Diabetes (Non
insulin-Dependent Diabetes Mellitus/NIDDM)

The most common form of diabetes is Type 2 diabetes, previously
known as Non-Insulin-Dependent Diabetes Mellitus (NIDDM), obesity
related diabetes, or adult-onset diabetes. Type 2 diabetes is the
more prevalent form and is characterized by insulin resistance and
relative insulin deficiency. Finally, the symptom of hyperglycemia
occurs. According to research, about 90 to 95 percent of diabetes
patient belonging to Type 2.

About 80 percent of patient with Type 2 diabetes are obese. In most
cases, symptoms of Type 2 diabetes are often absent or very mild
during the earlier years. It means that the onset symptoms of Type 2
diabetes slowly appear instead of suddenly occurring.

The acute onset of Type 1 diabetes usually occurs suddenly with
absolute insulin deficiency. In Type 2 diabetes, either the impaired
beta cell of the pancreas does not secret sufficient insulin because
of the deficiency in the response of pancreatic beta cells to
glucose, or the body tissues increases insensitivity or resistance
to the insulin. These patients generally manifest the symptom of
hyperglycemia (glucose toxicity).

The most common patient of Type 2 diabetes is an obese patient. In
the earlier years, most Type 2 and obese patients have an
insensitive body tissue to endogenous insulin, called insulin
resistance. To be able to respond to more and more glucose
production from body tissues and circulating blood glucose from
food, the pancreatic beta cells become hyperplastic. The
compensation action induces the hyperinsulinism.

After several years duration of hyperinsulinism combined with other
stimuli, insulin production then decreases. At this phase, the
symptoms of Type 2 diabetes are just about the same as Type 1
diabetes. Many evidences support that the Type 2 diabetes already
has abnormalities over 10 years but it is never diagnosed.

The majority of idiopathic Type 2 diabetes patients are none obese
Type 2 patients. These patients generally have deficiency of insulin
secretion at the earlier phase. These groups of Type 2 diabetes
patients have recently been reclassified within a group of “other
specific type of Diabetes Mellitus.

Type 2 diabetes usually occurs predominantly over age 55 years of
age and obesity, but it happens in all ages and races. Some group
populations have a higher degree risk and prevalence for developing
the Type 2 diabetes than others such as Asian Americans, Native
Americans and Alaska Natives, African Americans, Native Hawaiians,
Pacific Islander Americans, and Hispanic/Latino
Americans.

A person with obesity, a sedentary life style, previous history of
gestational diabetes, physical inactivity, family history of
diabetes, aging, genetic factors, and deficiency in the response of
pancreatic beta cells to glucose has more chance to develop and
aggravate the Type 2 diabetes. Today, Type 2 diabetes is
increasingly being diagnosed in children and adolescents.

Many obese patients are initially asymptomatic or have increase in
urination and thirst. Frequently, during the routine.

laboratory test, the diabetes is diagnosed due to the findings of
hyperinsulinism, hyperglycemia or glycosuria.

Many other patients may complain of chronic skin infections,
pruritus, vaginitis, neuropathy, hyperglyceridemia, distal symmetric
polyneuropathy, retinopathy, diabetic cataracts, and cardiovascular
complication prior to diagnosis of Type 2 diabetes. Therefore, the
complicated and multiple metabolic changes will continually impair
many organs and tissues. The most impaired organ is the
cardiovascular system. Most patient with Type 2 diabetes have very
little tendency toward ketoacidosis.

In Chinese medicine, the diabetes including Diabetes Mellitus and
Diabetes Insipidus are called Wasting and Thirsty disease or
syndrome, known as ‘Xiao Ke' Syndrome. The Etiology of ‘Xiao Ke' is
most due to congenital defect, improper diet, insufficient rest,
emotional stress, overwork, and excess sexual activities. The
abnormal pathogenic factors can result in deficiency of Yin, excess
of dry heat, and weakness of the five Zang. Usually, the excessive
pathogen of dry heat and deficiency of Yin impair the Lungs, Stomach
(Spleen), and Kidneys. Deficiency of Yin and the Pathogen of dry
heat leads to the symptoms of diabetes. The most common clinical
manifestations are polydipsia, polyphagia, polyuria, emaciation, and
urine with sweet taste. Sometimes it may have obstruction due to
blood stasis, when the condition of deficiency of Yin and excess of
dry heat become worse. In many circumstances, Chinese medicine can
help to reduce and prevent the symptoms and the complications from
the diabetes.

The main result of
pathogenesis is

·
The root of deficiency of Yin and the secondary cause of excess of
dry heat

·
Deficiency of yin essence due to depletion of the kidney essence

·Deficiency of both Qi and Yin

·
Deficiency of both Yin and Yang

·
Obstruction due to blood stasis, due to deficiency of upright Qi

·
Deficiency and depletion of Zang and Fu organs can cause hundreds of
pathogenic and changeable symptoms.

Differential diagnosis

Thirsty syndrome: thirsty symptom may appear in many different
diseases especially in excessive heat of febrile diseases. The
thirsty symptom is very similar to diabetes thirst except for
absence of polyuria, weight loss, polyphagia, and urine with a sweet
taste.

Goiter disease: Goiter syndrome mainly results from phlegm
accumulation due to stagnant Qi and hyperactivity of fire due to
deficiency of yin. The symptoms that appear are hunger, weight loss,
palpitation, irritability, bulging eyeballs and swelling on one or
both sides of the frontal neck. However, this syndrome doesn't have
the polyuria, polydipsia and urine with a sweet taste, swelling in
the neck, and bulging eyeballs.

Key points of
differential syndromes:

·
To distinguish the affected locations

·
To identify the root and branch

·
To clarify the original or associated syndromes

Differentiating
pathologic syndromes in accordance with San Jiao

According the theory of traditional Chinese medicine, Xiao Ken
syndrome is divided into three major types or areas (the Triple
Burners):

·
The Upper Jiao: The upper Jiao is involving the lung heat impairing
the Jing. The clinical manifestations are extreme thirst and
polydipsia. It is also called Upper Jiao diabetes. The pulse is
usually full and rapid. The tongue has dry and red at side and tip
with thin or yellow fur.

·
The Middle Jiao: The Middle Jiao is involving the excess of
flaming-Up heat in the stomach, which causes the extreme polyphagia
and emaciation. The tongue is yellow fur. The pulse is slippery and
forceful.

·
The Lower Jiao: The Lower Jiao is involving the deficiency of kidney
Yin that causes polyuria. The tongue is little fur. The pulse is
thready and rapid.

Acupuncture and Chinese
medicine treatment according to differential syndromes

Upper Xiao or Upper Jiao
diabetes

Symptoms: extreme thirst and polydipsia, dry tongue and mouth,
frequent urination with copious urine, red tongue at tip and side, a
thin yellow fur, and a full and rapid pulse.

Therapeutic principles: to clear the heat and increase the
production of the fluids for moistening the lungs

Acupuncture treatment:
mainly select the acupuncture points from the Hand-Taiyang and Hand-Taiyin
Meridians.

Seven-Star needling
treatment: around the spleen and stomach areas at middle back.

Lower Xiao or Lower Jiao
diabetes

Symptoms: polyuria with turbid and sweet urine, profuse urine,
weakness in the loins and knees, dizziness, dry mouth and lips,
dryness and itching skin, and tinnitus. The tongue is red with
little feathering. The pulse is rapid and thready.

Therapeutic principles: to nourish yin and to tonify the kidneys. To
relieve the thirst by moistening the dryness.

Acupuncture treatment:
mainly select the acupuncture points from the Foot-Taiyang and Foot-Shaoyin
Meridians.

Seven-Star needling
treatment: around the kidneys and bladder areas at lower back.

Deficiency of both Yin
and Yang

Symptoms: polyuria with large quantities of turbid urine, dry and
withered helixes, weakness in the loins and knees, cold limbs,
aversion to cold, impotence, dark complex. The tongue is pale with a
white and dry coating. The pulse is deep and thready.

Therapeutic principles: To nourish Yin, warm the yang, and to tonify
the kidneys.

Seven-Star needling
treatment : around the kidneys and bladder areas at lower
back.

Obstruction of blood
stasis

Symptoms: dry mouth, polyuria, weight loss, dark and unclear
complexes, numbness of extremities, stabbing pain; the tongue is
dark with blood stasis or expansion of veins under the tongue. The
tongue coating is either white or with little fur. The pulse id
slippery, or deep with resistance or irregular intervals